This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.

Monday, April 02, 2007

Students, are you curious?

As mentioned below, I am happy to take questions from students. Undergrads, graduate students, medical students, others. Any topic. Answers to selected questions will appear each week on Wednesday. Give it a try.

I'm a third year medical student in Charleston, WV. I'm having a tough time deciding what to be when I grow up. "Do what you love." Is the most common comment I get. This is a problem for me because so far I've loved everything. When I started medical school I was set on family medicine or general internal medicine. I still think I'd be happy with either of these options. However, sometimes I feel it might be a mistake for me not to specialize so I will have a more valuable skill when I finish.

As I try to better understand the issues of health care I sometimes wonder, "When it comes to the majority of issues a general practitioner sees, is there that big of a difference between a family doctor and an experienced PA?" When the number crunching of medical costs occurs will we discover that family doctors aren't worth what they're payed?

I have a small family (wife, one daughter) and plenty of loans. I feel a little discouraged by the reimbursement disparity between general practice and specialty practice. Do you think this pay gap will get even wider? What do you see as the future of primary care medicine in America?

How is the 40K we spend per year on medical school tuition spent? Many find this number exorbitant. Many students feel that they pay 160K for tuition only as purchase price for the piece of paper called a diploma... that they could get an equivalent education for a lot less money.

Yet schools claim that it costs them more to teach each student than it gets from tuition. I find this extremely hard to believe. I really wish that someone could lay out in a very transparent way, where does the tuition money go? How is it spent?

Being in my early 30s, I have had the opportunity to hold various middle management positions in administration at hospitals in major US cities.

My motivation for leaving each of those roles was due to the lack of perceived opportunity to ascend to more progressive levels of resposibility and in time, move to higher positions within the organization.

I often found myself questioning why there seemed to be a large gap in age between myself and others in middle management.

And then it dawned on me. I found in these 3 separate organizations, there was not much evidence of commitment to leadership succession and growth/development of earlier careerists. I considered that perhaps many future 20/30 somethings with gradudate degrees saw the same thing and jumped to another industry or organization where there was opportunity to contribute, learn and develop.

I still work in the healthcare industry but outside of hospitals, and my experience has and continues to serve me well in my current role.

Perhaps I had a run of bad luck, bad roles, bad supervisors or maybe I wasn't cut out to ascend in hospital operations. However, what if this situation is the norm rather than the exception in the hospital industry?

With all the challenges the hospital industry faces in the upcoming years:

a) where will the hospital leaders of tomorrow come from?b) How can hospital attract a qualified entry level and middle management workforce when other industries (banking, finance, law) offer more competitive salaries/benefits?

Mr. Levy, you strike me a visionary leader and one who deeply cares about his organization, employees and its future after he is no longer leading it.

How are you thinking about addressing the situation that some mid-level managers in hospitals perhaps face, as I did, and future sucession planning efforts such as those I mention above?

1) What is your take on pay for performance, and will it be integrated into BIDMC?

2)Do you see the new Massachusetts Healthcare Plan having the potential to increase access to good quality care? How will undocumented residents and current free care recipients be affected by the new healthcare reform bill. Will large hospitals retain their freecare pool?

I have just finished my undergrad in Sociology and will be pursing an MSc in Health Management this fall. As one of the few students in the programme coming directly from undergrad (and without a medical background), I decided to intern with Senior Management at a hospital.

One of the issues for me is that everyone, except for the CFO, comes from a clinical background. When I look at many of the VPs, much of their learning progressed as they moved through various clinician roles and eventually into Senior Management. As someone who will not move through these clinician roles, but is nonetheless interested in working in hospital management, what core competencies should I be focusing on during this short (6 month) internship?

I noticed that you are seeking topics for your Weds feature, and I was wondering if you had seen my post from April 6th above about hospital future succession? Am very curious to know your thoughts on this.

I'm finishing up my MHSA, 2 years of class (3.7) and 1 year of residency in the VA system. I went into the masters program directly from undergrad.

Before the VA I did a 6 month internship with an Orthopaedic group where I did a stellar job; all of the surgeons loved me, and I saved them money by tightening up their systems.

After a year with the VA I feel like the [professional] life has been sucked out of me. It seems impossable to accomplish anything in the government beurocracy.

Should I give up on the VA and start hunting for a job in the private sector, or should I remain faithful to the organization that gave me a shot and tell myself that if I stay long enough I can change things for the better.

My name is Peter "Rocky" Samuel, and I am a first year medical student at Harvard Medical School. I went to medical school to help provide the best care for patients, and my interests in healthcare management stem from that same goal. Do you ever find that the decisions you make may be great for the hospital but not the best option for patients? This comes up repeatedly in the pharmaceutical industry, where often the products being developed are directed toward the business market and not the greater burden of illness. Hospitals generally generate surpluses from providing cardiac and cancer care but lose money providing mental health and pediatric care. Are you ever forced to put a higher priority on the well being of the hospital than on providing the best healthcare services for the well being of patients, and how do you grapple with that?

I'd be curious to get your thoughts on medical tourism. Will it be big? Should one look to it as a possible career area (assisting in the logistics..maybe not so much the clinical side.) Thanks for taking our questions!

I'm a Ph.D candidate in the field of organizational psychology. My dissertation focuses on the role of physician champions during EHR, CPOE and other enterprise-wide medical IT implementations.

As I'm sure you're aware, any IT implementation that affects clinical workflow can be huge risk to a healthcare facility -- there are many documented examples of multi-million dollar efforts that have simply failed, leaving budgets depleted and staff members scarred.

I'd be very interested in hearing a little bit about how you approach IT implementations, particularly when they involve the clinical staff. What do you do to minimize the risk of failure?

As a BIDMC IS employee, I am finding that I am very interested in getting more involved in hospital administration. Would a BS in Management and IS experience at BIDMC give me that chance? Would it be difficult to make that transition? I imagine many employees come over to IS but not visa versa. Thanks!

I am an undergraduate at MIT in the biology program. During high school I was able to volunteer often. As former head of the referee program for the local soccer organization, I enjoyed your post on being a soccer referee.

Now that I am in college, I have been looking to obtain some medical related experience through volunteer work. I have tried the volunteer programs at some Boston hospitals, but I did not find them to be meaningful. They would generally consist of pushing patients around. I feel this is much less helpful than serving people in a soup kitchen or homeless shelter. Moreover, the volunteer sheet would often be filled months in advance, so it was as if me being there did not help anybody at all because many others were clamoring for the precious volunteer hours. The supply vastly exceeded demand. Overall, the activity seemed to be just designed to be put on a piece of paper or medical school application instead of being a program that really helped people.

Do you have any recommendations for volunteer activities which provide medical experience and help people in a meaningful way in the Boston area, and which are accessible by public transportation for us poor undergraduates?

I have a public health PhD, and I enjoy my research, but it bores me to work alone all day long, even when I go to seminars and chat with people. My field has lots of MD/PhDs and just MDs. I started a postdoc, and could go on to a faculty job in a med school or public health school, or to a think tank.

I've thought about getting an MD or NP if I'm not happier in a couple of years because then I could see patients some of the time. Like lots of kids, I "always" wanted to be a doctor, but by the time I got to college I was a snob about memorization and thought premeds were tools, so it's a long-dormant but not new thought.

I wouldn't consider either option until I've been out a couple of years, but what are some considerations that I should think about?

Here's a new kind of question for you...I'm currently an undergrad student and also a patient at BIDMC, and I recently started riding my bike to my weekly appointments. I was disappointed the first time I rode up to the entrance and found no bicycle racks. Maybe I didn't see them, or maybe the building I go to is the only one without racks. It would be great if some racks were installed on the BIDMC campus (if not already there), or can you tell me where they are located?

I think bike racks would be beneficial to the BIDMC community. Although this may seem trivial, it can be difficult to find a place to lock your bike to. I believe bike racks would encourage people to ride their bike to work or appointment instead of driving. Also, for those of us without cars, it is nice to save a few bucks by not having to ride the T or bus.

This could be considered a public health issue since built environment plays an important role in health. One comment responding to the post "A Medical Student Grows and Learns" mentioned the need to improve the physical environment. This is one example of an improvement that can make a difference.

Thanks for your consideration.

Also, I'm a huge fan of your blog. It's very encouraging to know that humor is still appreciated - especially from someone in the hospital administration field.

I wanted to commend your hospital for making its quality data transparent to the public and for creating an environment of accountability. I am a graduate student in health services research interested in studying healthcare quality and I wanted to know your views on hospital performance measures.

In the face of resource constraints, do you think there are any unintended consequences of publicly reporting on performance indicators where hospitals may be devoting more of their resources to areas being measured by the Joint Commission/CMS while other areas of care that are not currently measured may be declining? If so, what might those unintended consequences be?

Also, in a competitive market like Boston, do hospitals compete on these performance indicators or are they competing on other dimensions of “quality” such as amenities (facilities/services)? Thank you in advance for your insights!